Provider Demographics
NPI:1295417236
Name:DIAZ, PAUL THOMAS
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:THOMAS
Last Name:DIAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6696 US HIGHWAY 20A
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:OH
Mailing Address - Zip Code:43515-9799
Mailing Address - Country:US
Mailing Address - Phone:419-822-3242
Mailing Address - Fax:
Practice Address - Street 1:6696 US HIGHWAY 20A
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:OH
Practice Address - Zip Code:43515-9799
Practice Address - Country:US
Practice Address - Phone:419-822-3242
Practice Address - Fax:419-822-9008
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0034262363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily